Increase infant Vitamin D: forification, daily, weekly, monthly, breast milk - Review June 2022

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Different Vitamin D Supplementation Strategies in the First Years of Life: A Systematic Review

Healthcare 2022, 10(6), 1023; https://doi.org/10.3390/healthcare10061023
Antonio Corsello 1 , Gregorio Paolo Milani 1,2, gregorio.milani at unimi.it , Maria Lorella Giannì 1,3 , Valeria Dipasquale 4, Claudio Romano 4,† and Carlo Agostoni 1,2,†

• 1 Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; antonio.corsello at unimi.it (A.C.); maria.gianni at unimi.it (M.L.G.); carlo.agostoni at unimi.it (C.A.)
• 2 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
• 3 Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
• 4 Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy; dipasquale.valeria at libero.it (V.D.); claudio.romano at unime.it (C.R.)

Vitamin D (VD) is an essential micronutrient with multiple functions for human growth, and adequate intake should be guaranteed throughout life. However, VD insufficiency is observed in infants all over the world. Low VD concentration in the breast milk of non-supplemented mothers and low compliance to VD daily supplementation are the main causes of VD insufficiency, especially in the long term. Furthermore, VD supplementation dosages are still debated and differ by country. We conducted a systematic review to compare the most recent evidence on different postnatal VD supplementation strategies, determining whether supplementation given to the mother is as effective as that administered directly to the child, and whether different dosages and administration schedules differ significantly in terms of efficacy and safety. We identified 18 randomized controlled trials (RCTs) addressing the role of infant (n = 961), maternal (n = 652) or combined infant and maternal VD supplementation (n = 260 pairs). In all studies, similar outcomes emerged in terms of efficacy and safety. According to our findings, alternative approaches of VD supplementation may be adopted, especially in cases where the adherence to daily supplementation strategies is poor. This review shows that different dosages and supplementation strategies result in similar VD sufficiency rates. Therefore, international guidelines may be revised in the future to offer multiple and different options of supplementation for specific settings and ages.
 Download the PDF from VitaminDWiki

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VitaminDWiki

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Adding Vitamin D should not stop after age 1, after rickets, after no-longer a premie

Some counrties cease giving free Vitamin D at age 1
Most countries incorrectly cease giving extra Vitamin D once rickets has been cured

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Dose size should increase as weight increases

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Very similar benefits and safety with daily, weekly, and once every two weeks

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VitaminDWiki - Infant-Child category has 824 items contains

• No consensus on MINIMUM International Units (IU) for healthy infant of normal weight
• 400 IU Vitamin D is no longer enough
  Was OK in the past century, but D levels have been dropping for a great many reasons.
  FDA doubles the amount of vitamin D permitted in milk – July 2016
• No consensus: range is 600 to 1600 IU – based on many randomized controlled trials
• Review of 400 IU to 2000 IU daily and higher if non-daily
• Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
• 1600 IU was the conclusion of three JAMA studies
     1000 IU recommended in France and Finland – 2013 - appears to be a good level
• 5X less mite allergy after add vitamin D
• Child bone fractures with low vitamin D were 55X more likely to need surgery
• 75 % of SIDS had low vitamin D
• Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
• 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
• Infants have gotten free 400 IU of vitamin D in Turkey since 2005, More for longer would be even better – Feb 2022
• Preemies should have vitamin D supplements – reaching an agreement – April 2021
• Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021

Having a good level of vitamin D cuts in half the amount of:

• Asthma, Chronic illness, Doctor visits, Allergies, infection
  Respiratory Tract Infection, Growing pains, Bed wetting

Need even more IUs of vitamin D to get a good level if;

• Have little vitamin D: premie, twin, mother did not get much sun access
• Get little vitamin D: dark skin, little access to sun
• Vitamin D is consumed faster than normal due to sickness
• Older (need at least 100 IU/kilogram, far more if obese)
• Not get any vitamin D from formula (breast fed) or (fortified) milk
  Note – formula does not even provide 400 IU of vitamin D daily

Infants-Children need Vitamin D

• Sun is great – well known for 1,000’s of years.
  US govt (1934) even said infants should be out in the sun
• One country recommended 2,000 IU daily for decades – with no known problems
• As with adults, infants and children can have loading doses and rarely need tests
• Daily dose appears to be best, but monthly seems OK
• Vitamin D is typically given to infants in the form of drops
     big difference in taste between brands
     can also use water-soluable form of vitamin D in milk, food, juice,
• Infants have evolved to get a big boost of vitamin D immediately after birth
  Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare
• 100 IU per kg of infant July 2011, Poland etc.
  
  More than 100 IU/kg is probably better
• 824 items in the category Infant/Child See also
• 34 pages in VitaminDWiki had BREASTFE*in title as of Jan 2022
• "BIRTH DEFECTS" 172 items as of July 2016
• Stunting OR “low birth weight” OR LBW OR preemie OR preemies OR preterm 1940 items as of Oct 2018
• 96 VitaminDWiki pages contained PRETERM or PREEMIE in title as of Aug 2021
• "SUDDEN INFANT DEATH" OR SIDS 214 items as of Dec 2020
• Overview of Rickets and Vitamin D
• Youth category listing has 174 items along with related searches
• Down syndrome and low vitamin D - several studies
• Rett syndrome associated with low vitamin D, treated by Omega-3

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VitaminDWiki - Weekly, Monthly Vitamin D are typically better than daily - many studies